Borage (Borago officinalis) is an herb native to Syria that has spread throughout the Middle East and Mediterranean. Borage flowers and leaves may be eaten and borage seeds are often pressed to produce oil very high in gamma-linolenic acid (GLA).

Borage is popularly used for premenstrual syndrome (PMS) and menopausal symptoms. Borage is also popular among elderly women. Borage is known for its anti-inflammatory properties and has been studied for the treatment of gum disease, rheumatoid arthritis, and asthma.

There is currently controversy about the safety of borage. Consumers should use caution when taking borage as there have been cases of poisoning after confusion with foxglove.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

Acute respiratory distress syndrome occurs when the lung malfunctions due to injury to the small air sacs and the capillaries of the lungs. Borage may improve heart and lung function and reduce lung inflammation in acute respiratory distress syndrome.

B

Preliminary evidence suggests that borage has anti-inflammatory effects that may make it beneficial in treating periodontitis (gum disease). Additional research is needed to determine the best dosing and administration of borage oil.

B

Preliminary evidence suggests that gamma linolenic acid (GLA) has known anti-inflammatory effects that may make it beneficial in treating rheumatoid arthritis. Additional research is needed to determine the optimal dose and administration.

B

Borage oil may help treat or prevent alcohol-induced hangovers, although additional study is needed in this area.

C

Preliminary evidence suggests that gamma linolenic acid (GLA) may have some immunosuppressant activity that may be helpful in reducing asthma symptoms.

C

Atopic dermatitis is a skin disorder that is characterized by itching, scaling, thickening of the skin and is usually located on the face, elbows, knees, and arms. The evidence for borage oil in the treatment of atopic dermatitis is mixed. Additional study is needed in this area.

C

Cystic fibrosis is a genetic disorder affecting the mucus lining of the lungs leading to breathing problems and other difficulties. Preliminary evidence indicated that borage oil may have some benefits in cystic fibrosis patients.

C

Hyperlipidemia means that there are excess levels of fats in the blood. These fats can be triglycerides or cholesterol. Hyperlipidemia is often associated with increased risk of heart disease and strokes. Gamma linolenic acid may decrease plasma triglyceride levels and increase HDL-cholesterol concentration. However, more research is needed to define borage's effects on lipid levels in the blood.

Currently, there is insufficient available evidence evaluating the effectiveness of borage in the treatment of malnutrition.

C

Seborrheic dermatitis is a type of inflammatory skin rash. Currently, there is insufficient evidence to support borage in the treatment of seborrheic dermatitis.

C

Borage oil may decrease heart changes to acute stress. More high quality studies are needed in this area.

C

A borage oil-containing formula does not appear to affect preterm and very low birth weight infants, although more study is needed in this area.

C

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Borage is likely safe when used in food or spice amounts or when 1-3 grams is used daily in healthy adults for up to 24 weeks.

There is no proven effective dose for borage. However, 2-3 grams daily GLA (borage oil) for 24 weeks to 12 months has been used for asthma. For atopic eczema, 500-3,000 milligrams of borage oil-containing capsules daily for 12-24 weeks has been used.

Children (under 18 years old)

There is no proven safe or effective dose for borage in children. Nonetheless, two capsules of borage oil twice daily for 12 weeks have been used. For prevention of atopic dermatitis, a borage oil supplement containing 100 milligrams gamma linolenic acid daily for the first six months of life has been used.

Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in individuals with a known allergy or hypersensitivity to borage or its constituents.

Side Effects and Warnings

Borage has been confused with foxglove and ingestion of foxglove leaves has caused accidental poisoning.

Borage may lower the seizure threshold. Use cautiously in patients with epilepsy or taking anticonvulsants.

When used in combination with other herbs and supplements, borage may lower blood sugar levels.

Use cautiously in patients with bleeding disorders or taking warfarin or other anticoagulants or antiplatelet agents, as borage seed oil may increase the risk of bleeding or potentiate the effects of warfarin therapy.

Avoid in patients with compromised immune systems or similar immunological conditions.

Pregnancy and Breastfeeding

Borage is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence. One pregnant woman using borage seed oil complained of mild intestinal gas. Gamma linolenic acid, which is found in borage, may alter breast milk production.

Borage may have antibacterial effects against Helicobacter pylori. Use cautiously with antibiotics and antiulcer medications due to possible additive effects.

Borage may increase the risk of bleeding, especially when taken with drugs that increase the risk of bleeding, such as warfarin therapy.

Preliminary evidence suggests that borage may lower the seizure threshold. Use cautiously in patients with seizures or taking anticonvulsant medications.

Preliminary evidence suggests that borage oil may have anti-inflammatory properties. Use cautiously with anti-inflammatory medications due to possible additive effects.

Although not well studied in humans, gamma linolenic acid may decrease plasma triglyceride levels and may increase HDL-cholesterol concentration. Use cautiously in patients taking cholesterol-lowering medications due to possible additive effects.

Although not well studied in humans, borage may have antibacterial effects against Helicobacter pylori. Use cautiously with herbs and supplement that may have antibacterial or antiulcer activity.

Preliminary evidence suggests that borage seed oil may potentially increase the risk of bleeding or potentiate the effects of warfarin therapy. Use cautiously with bleeding disorders or with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto.

Preliminary evidence suggests that borage may lower the seizure threshold. Use cautiously in patients with seizures or taking anticonvulsant herbs or supplements.

Preliminary evidence suggests that borage oil may have anti-inflammatory properties. Use cautiously with anti-inflammatory herbs or supplements due to possible additive effects.

Although not well studied in humans, gamma linolenic acid may decrease plasma triglyceride levels and may increase HDL-cholesterol concentration. Use cautiously in patients taking cholesterol-lowering herbs, such as red yeast rice, due to possible additive effects.

Borage oil may alter heart function. Use cautiously in patients with heart conditions or taking cardiovascular herbs or supplements.

Preliminary evidence suggests that gamma linolenic acid may alter immune responses. Use cautiously with other immunomodulators.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.